Peripheral artery disease: a global need for detection, prevention, and treatment
Authors: Lars Norgren
Journal: The Lancet Global Health (2023)

I read with interest the study by Min Seo Kim and colleagues1GBD 2019 Peripheral Artery Disease CollaboratorsGlobal burden of peripheral artery disease and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019.Lancet Glob Health. 2023; 11: e1553-e1565Summary Full Text Full Text PDF Scopus (1) Google Scholar on the global burden of peripheral artery disease and its risk factors, based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. The study is of interest because it provides not only estimates of prevalence, incidence, and death, but also of disability-adjusted life-years (DALYs). An estimation of DALYs increases the information on health effects of peripheral artery disease, which is of importance for public health practice. Previous studies have found a higher prevalence of peripheral artery disease in women,2Kavurma MM Boccanfuso L Cutmore C et al.A hidden problem: peripheral artery disease in women.Eur Heart J Qual Care Clin Outcomes. 2023; 9: 342-350PubMed Google Scholar and this finding was verified in the study by Kim and colleagues for both low-income and high-income populations. However, DALYs were found to be similar between sexes, and also between low-income and high-income countries. The authors concluded that peripheral artery disease is not adequately managed in low-income countries, which was also supported by Sampson and colleagues3Sampson UKA Fowkes FGR McDermott MM et al.Global and regional burden of death and disability from peripheral artery disease: 21 world regions, 1990 to 2010.Glob Heart. 2014; 9: 145-158Crossref PubMed Scopus (202) Google Scholar in their analysis of DALYs between 1990 and 2010, which found higher median DALYs in both men and women in low-income versus high-income countries. An obvious question is to what extent reported basic data are complete. Incompleteness could be caused by several factors that might be more prominent in low-income settings. First, registrations can fail due to unreliable systems or poor adherence to reporting, or an incorrect diagnosis. Second, people might not seek medical advice due to a lack of knowledge, poverty, and other socioeconomic factors. Two problems should therefore be considered: a substantial proportion of individuals with peripheral artery disease are not detected, and others do not receive correct prevention or treatment. Informing the public about peripheral artery disease and its risk factors is crucial, and methods of communication that also reach populations in low socioeconomic and low-income areas should be developed and improved. As reported by Kim and colleagues, about 70% of the peripheral artery disease burden in 2019 was caused by modifiable risk factors. Unfortunately, there is also poor knowledge and understanding of peripheral artery disease among health-care staff.4Nordanstig J Behrendt CA Bradbury AW et al.Peripheral arterial disease (PAD)—a challenging manifestation of atherosclerosis.Prev Med. 2023; 171107489Crossref PubMed Scopus (3) Google Scholar In a broader context, cardiovascular prevention is the key to reducing the burden of cardiovascular diseases such as peripheral artery disease, both in terms of addressing risk factors for population prevention, and in using antiplatelet treatment for symptomatic individuals. The role of more expensive treatment, such as revascularisation, will depend on access to endovascular and open surgery, which clearly differs between regions and countries.5Fowkes FG Forster RB Levin CE et al.Prioritisation of treatment for lower extremity peripheral artery disease in low- and middle income countries.Int Angiol. 2017; 36: 203-215Crossref PubMed Scopus (13) Google Scholar The major finding in this study of GBD data—lower peripheral artery disease prevalence but similar numbers of DALYs in males and low-income countries compared with women and high-income countries—requires further analysis for better understanding and guidance on which measures are most important to address. Examples are increased information on the danger of smoking and improved care of diabetic patients to reduce the risk of amputation. The study invites context-specific reflection and action on a global level. I declare no competing interests. Global burden of peripheral artery disease and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019The total number of people with peripheral artery disease has increased globally from 1990 to 2019. Despite the lower prevalence of peripheral artery disease in males and low-income countries, these groups showed similar DALY rates to females and higher-income countries, highlighting disproportionate burden in these groups. Modifiable risk factors were responsible for around 70% of the global peripheral artery disease burden. Public measures could mitigate the burden of peripheral artery disease by modifying risk factors. Full-Text PDF Open Access